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NHS reform

David Lock: “Privatisation regulations” mean big change

4 Apr, 13 | by BMJ Group

It is not every day that the Department of Health produces a formal response to two of my dry (and I accept potentially fairly boring) legal opinions.  23 March was a red letter day because it was the first time it has happened.  The department produced a formal response to material I and my fellow barrister, Ligia Osepciu, produced for the campaigning organisation 38 degrees about the NHS (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013, which I have referred to (neutrally) as “the privatisation regulations” since the full name is a bit of a mouthful.

Should I have felt honoured or did it mean that the Department of Health has “marked my card” and I will never be asked to give legal advice to them or any NHS body ever again?  Only time will tell.  However overall I was more than a little disappointed at the quality of the response.  It does, however, show how sensitive ministers are about others commenting on how the privatisation regulations will change the NHS but overall it ducked the main issues and pretended that the regulations brought in little change, which is simply not correct. more…

Richard Smith: Should the first priority of the NHS be to stop us dying or to help us die well?

2 Apr, 13 | by BMJ Group

Richard Smith Good Friday is an excellent day for thinking about death, but I think about death every day. I find it energising. As I write this blog on Easter Sunday, I read that Bruce Keogh, the medical director of NHS England, thinks that the first priority if the NHS is to stop us dying.  Minutes after reading that I read in The Atlantic a piece entitled “The coming death shortage: why the longevity boom will make us sorry to be alive.”  Who. I wonder, is on the side of the angels? more…

David Lock: A new and very different type of NHS in England

2 Apr, 13 | by BMJ Group

April 1 2013 saw the launch of a very different type of NHS in England.  The current government has grappled with the same problems as all previous governments, but imposed radical surgery on an ageing patient.

The previous government struggled with the problem of getting improved productivity and common high standards out of a largely monopoly service.  The NHS has always delivered its services through a mixture of employed staff and contracted private sector operators.  GP practices have always been private sector businesses that are paid by the NHS for the services they deliver, but without GPs ever being NHS employees.  How they swung the right to get NHS pensions is another story but just shows the negotiating brilliance of the BMA.  But competition plays only a small part in GP services.  There is no active recruitment by one practice of the patients signed up to the practice down the road (although maybe we will see this now). more…

Felix Greaves: New beginnings, and new risks in English public health

28 Mar, 13 | by BMJ

felixAh, spring time. A time of new beginnings. Daffodils sprouting through the snow. And like hesitant young lambs, looking around at their unpleasantly cold surroundings, the new structures responsible for England’s public health will pop into being this chilly bank holiday weekend. After a marathon of consultations, delays, and clarifications, public health will complete its move out of the NHS and into local authorities.

What does this mean for public health doctors like me? Well—I don’t think anybody really knows yet. But we’re soon going to find out the answers to some of the big questions. Will the director of public health report to the chief executive, or the director of adult social services? How, if at all, will we feed into the new CCGs? And a particularly pressing issue: how much money will public health have, and who will be in control of it? more…

David Pencheon: Don’t always put patients first.

26 Jul, 12 | by BMJ

David PencheonPatient health, patient experience, and health outcomes for individuals and populations should always be at the heart of the NHS. But the best way to actually achieve this most effectively might be to address it more obliquely. more…

Anna Dixon: Evolution or revolution: the story behind the Health and Social Care Act 2012

17 Jul, 12 | by BMJ

Anna DixonIt was often difficult to know who to believe during debate about the Health and Social Care Bill. The public were faced with baffling technocratic details from government with no accompanying compelling narrative to explain the need for such significant reforms, alongside sensationalised claims from some who opposed it that the bill spelt the end of the NHS as we know it.

In his account of the story behind the bill, published yesterday by The King’s Fund and the Institute for Government (IfG), Nick Timmins sets the record straight. Through interviews with key players involved in the action, analysis of public speeches and documents, and his own personal observations as a journalist reporting on the bill, Nick has produced an illuminating account of the policy making process and suggested some lessons for government. The IfG have elaborated on some of the wider lessons for policy making. But how revolutionary were the reforms? Were they just a continuation of the market reforms begun in the early 1990s? And could any of these “mistakes” have been avoided if lessons had been heeded from previous major reforms to the NHS? more…

Ike Anya: Can public health hold it all together in the new fragmented English NHS?

11 Jul, 12 | by BMJ

Following the recent Health and Social Care Act, which profoundly changes the structure of the NHS in England, one of the concerns that persists is the potential fragmentation of services and the impact of this fragmentation on patient pathways and care.

Under the old system, each Primary Care Trust had the clearly defined responsibility of directly or indirectly providing or commissioning all health services for its residents. If a resident had a problem with access to, or quality of health services; whether it was a primary care service, a community service, a hospital service, or a public health programme, it was the responsibility of the Primary Care Trust to sort it out. more…

Martin McShane: Walk the talk

26 Jun, 12 | by BMJ

Martin McShaneSometimes, it becomes apparent that what we have been talking about for so long is actually beginning to happen.

Over the last few weeks we have been preparing for our Annual Accountability Review with the SHA. We have had our monthly cluster board meeting. We also had a meeting with the acute trust, looking at mortality. Then there was the NHS Confederation conference. Meanwhile the commissioning support services were re-launching a new and improved CCG dashboard to track activity and variation. more…

Martin McShane: Letting go

1 Jun, 12 | by BMJ

Martin McShaneOne aspect of my job that I have enjoyed over the last few years has been engaging with the public. It has never been dull. When I first arrived in Lincolnshire we did a lot of work, talking with the public and professionals about the principles we should use for commissioning services. This became a consultation called Shaping Health for Lincolnshire. It helped, I believe, set a new tone for the way commissioning was regarded and a new way of working with people to make change happen. more…

David Zigmond: Further NHS reforms – inevitable and unintended consequences

30 May, 12 | by BMJ

As the debate becomes more fraught, I want to add my voice to the fray. I have been a frontline medical practitioner for more than 40 years, and have seen recurrent waves of reform and their very mixed results. The least disputable advances are in the realms of technology and technical competence: drugs and procedures have become more accurate and effective, practitioners mostly apposite in their delivery. Likewise, a few decades ago we all knew of doctors widely reputed as rude, curt, alcoholic, incompetent, and shabby—sometimes simultaneously. In those times, with moderate luck, they would retire, without formal challenge, on a full NHS pension. That kind of collusive incompetence is now most unlikely. These changes represent real progress. more…

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